Working Spouse/OEI Rule
What is the Working Spouse/OEI Rule?
In order to make sure CMU is able to offer the best coverage possible to those who need it most, the self-funded medical/prescription and dental plans include a spouse/other eligible individual (OEI) eligibility rule. Working spouses/OEIs of CMU staff, fixed-term faculty, medical faculty, and post-doctoral research fellows who have access to coverage through their own employer and the employer pays any portion of the cost of the coverage, must enroll in a minimum of single coverage with their employer.
My spouse/OEI has to take their employer’s insurance, which is not as good as CMU’s and I have to continue paying two person or family to maintain secondary coverage for them (and pay the single premium for their employer’s coverage). How is this fair?
CMU strongly believes that it’s our responsibility to provide the best healthcare coverage possible to our employees and eligible children, and that other employers should take the same responsibility for their own employees. The truth is that when our costs increase because of spouse/OEI claims, the cost for all of our employees – including employees with single coverage – rise also.
Are there any exceptions to the Working Spouse/OEI Rule?
Yes, your spouse/OEI is EXEMPT if they are:That said, the Working Spouse/OEI Rule applies EVEN IF any of the following apply:
What if my spouse/OEI and I are both CMU benefit-eligible employees?
The Working Spouse/OEI Rule does not affect those employees who are married or are in a relationship with an OEI and both work at CMU. Remember, you cannot cover each other and/or children on separate medical/prescription, dental and vision plans. One of you will need to elect two person (employee plus 1 other dependent) or family (employee plus 2 more dependents) coverage.
Will the Working Spouse/OEI Rule affect my spouse/OEI if they are not employed?
Your spouse/OEI will not be affected by the Working Spouse/OEI Rule. However, if your spouse/OEI becomes eligible for medical/prescription and/or dental coverage through their employer during the year and their employer pays any portion of the cost of the coverage, your spouse/OEI must enroll in at least single coverage with their own employer.
Does the Working Spouse/OEI Rule mean CMU may still provide medical/prescription and/or dental coverage for my spouse/OEI?
Yes. If your spouse/OEI is enrolled in their own employer’s medical/prescription and/or dental plans, CMU will provide your spouse/OEI with secondary coverage under CMU’s benefit plan. Your spouse/OEI’s employer’s plan will be responsible for the initial processing and payment of claims in accordance with their plan. Any unpaid balances may then be submitted to CMU’s benefits plan for processing under Coordination of Benefits.
What if my spouse/OEI’s employer asks for proof of CMU’s Working Spouse/OEI Rule?
The CMU Choices Flexible Benefit Plan Document/Summary Plan Description includes the Other Health Coverage provision. Your spouse/OEI can provide their employer with a copy of the plan document.
What happens if my spouse/OEI’s health coverage is terminated because they lost their job?
If a spouse/OEI loses coverage, the event qualifies as a benefits status change event and your spouse/OEI can be enrolled in CMU’s health plan, if not enrolled. You must submit a completed Status Change Request form to CMU’s Benefits & Wellness office within 30 calendar days of your spouse/OEI losing coverage to be enrolled in CMU’s plan.
Does the Working Spouse/OEI Rule apply to CMU’s vision plan?
Does this rule affect my children’s coverage?
No. Children will continue to be eligible for the CMU Choices benefits plan as long as they continue to meet the eligibility requirements, as outlined in the Dependent Eligibility Criteria Grid.
What if my spouse/OEI’s plan is a Health Savings Account (HSA) compatible plan?
To be eligible to contribute pre-tax dollars into an HSA, an individual must be covered by an HSA qualifying High Deductible Health Plan (HDHP) and cannot be covered by other health insurance that is not an HDHP. This means that your spouse/OEI will need to decide whether:THE IRS DOES NOT ALLOW BOTH. You may refer to the US Department of the Treasury website for more details.